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What is pay-for-performance?

Pay for performance (P4P) a healthcare payment system where the medical practitioners are paid for the quality of the services they offer. The payment is usually for the efficiency they show in their work. In this context, efficiency is defined as a high quality of work. The Federal government ha started adopting this system although they are still in the infancy stage so that there is no data to evaluate the performance of this system.

How could it stimulate or encourage EMR adoption?

There is interesting debate about this issue. If the overall performance will be rated and that the total number of patients attended by the physician is directly proportional to the incentive, the use of computers will be obvious. The Electronic Medical Records will gain popularity with the incentives method. Many physicians are willing to learn the use of technology in the quest to get more patients. In the UK the, the incentives are done by use of PAP smears. If a physician smears 90% of women between the ages of 20 and 65 then they would qualify for an incentive of $4000 annually. The ability and the rewards of using machines will give the physician the ability to meet the target easily. The EMR adoption is highly likely to increases with this new system (Varshney, 2009).

What are the advantages and limitations of cost-benefit analysis for IT adoption decisions?

The advantages of adopting IT solutions in hospitals include the fact that many operations will be done using minimal time. With effective systems, it is possible to achieve bulk work with minimum time. For issues like clerical and accounting, having an EMR is cost effective.

Another advantage is the fact that there will be motivation in the side of the doctors and nurses. It is this way because they will get to achieve more in their line of duty which translates to getting more in the end. The use of PAP smears helps doctors to do a lot, especially if the pay-for-performance initiative is implemented.

The limitations of implementing on EMR is that in cases where the patients need special attention, the systems will not have the human understanding. It will be hard to change the system to suit the challenging circumstances (Varshney, 2009). If the systems have been programmed such that will not allow a process to be processed before another process, then in cases where the patient need immediate doctor attention, it will be hard to skip the rigoral process.

Another limitation is that in case there is system failure, it will be hard for the doctors to cope with the failure. Today's systems are complex in their creation so that a doctor will not diagnose the system successfully using the common knowledge. Today's systems use complex programming languages.

Cost benefit analysis

Item

Price

Computer server

3000 USD

Host computers

1000 USD each *100 = 100000 USD

Networking of computers

500 USD

Training of staff

1000 USD

Information system

3000 USD

System failure

500 USD

Total

108000

Projected revenue

It will be expected that the use of information system will bring more revenue to the hospital. As more people get served and more information is spread about the efficiency of the system, more people will come to the hospital for treatment. It is expected that each patient will pay 100 USD per visit.

Year

Patients

Revenue

0

-

-108000 USD

1

700

70000 USD

2

900

90000 USD

3

1200

120000 USD

4

1500

150000 USD

5

2000

200000 USD

Total

122000 USD

Suppose the practice had decided not to adopt EMR. What would have been the "cost" of such a decision?

The opportunity cost of implementing this system is as follows:

Item

Cost

Employ new staff (starting with 100 each earning 1000 USD

100000 USD

Train new staff

2000 USD

Set the housing allowances for the staff

50000 USD

Set aside medical allowance

50000 USD

Total

202000 USD

As it is clear from the table above, it is expensive to use the manual system in a hospital. The EMR implementation automates many processes thus not requiring any staff to be there to do those jobs. What is more, human beings get tired unlike machines which are not fatigued.

What milestones should be achieved, in terms of IT readiness, before a group practice decides to implement EMR?

The milestones that should be achieved include the having acquired the right hardware for the whole system. There should be the server and desktop computers having being bought. There also should be the identification of a good vendor who will supply the right information system that will be used in the hospital. The system should have been confirmed to be working and not prone to failure (Varshney, 2009).

Another milestone to this is that the whole system is secure and that it is not prone to attacks. All loopholes to the system should be identified. If the system is web-based that will make it a requirement that the system be scrutinized and have the right protection mechanisms so that Internet based attacks are not met.

There should have been training of staff that will use the system. The system will not work without the support from the staff who will be issuing instructions to the system.

Could there be less of an incentive and different set of challenges for smaller practices to take on HMIS projects such as EMR implementation than large-scale health services organizations, such as a multi-provider health maintenance organization? If so, what are the differences? In terms of the incentives, why or why not?

There is an incentive that in small practice to take on these projects. The small practices find the implementation costs of these projects to be high and they cannot afford. Also in this line is the fact that they can manage the flow of patients without the use of these systems. They are not interested in using this system because they feel they are able handle the clients and also they are not ready to hire more staff to work in that line. In terms of incentives, there is a difference in that the facilities that are found in the small practices cannot handle the many patients that will come because of the efficiencies of the doctors. As more doctors and nurses strive to serve many patients, the facilities that have been set in place cannot manage to take the extra people.